A method to simulate incentives for cost containment under various cost sharing designs: an application to a first-euro deductible and a doughnut hole

Many health insurance schemes include deductibles to provide consumers with cost containment incentives (CCI) and to counteract moral hazard. Policymakers are faced with choices on the implementation of a specific cost sharing design. One of the guiding principles in this decision process could be which design leads to the strongest CCI. Despite the vast amount of literature on the effects of cost sharing

Perceptions of Time, Cost and Quality Management on Building Projects

This paper examines the relative intrinsic importance of the effective management of projecttime, cost and quality in the attainment of client objectives. The findings from a questionnairesurvey are presented. The survey explored the perceptions of South Africanclients concerning their objectives and the project time, cost and quality management associatedwith building procurement systems in South Africa. The findings indicate thatmis-perceptions exist between clients, contractors and building professionals regardingthe time, cost and quality management associated with building projects, and the contributionthis makes to the attainment of client objectives

IoTSan: Fortifying the Safety of IoT Systems

Today's IoT systems include event-driven smart applications (apps) that interact with sensors and actuators. A problem specific to IoT systems is that buggy apps, unforeseen bad app interactions, or device/communication failures, can cause unsafe and dangerous physical states. Detecting flaws that lead to such states, requires a holistic view of installed apps, component devices, their configurations, and more importantly, how they interact. In this paper, we design IoTSan, a novel practical system that uses model checking as a building block to reveal "interaction-level" flaws by identifying events that can lead the system to unsafe states. In building IoTSan, we design novel techniques tailored to IoT systems, to alleviate the state explosion associated with model checking. IoTSan also automatically translates IoT apps into a format amenable to model checking. Finally, to understand the root cause of a detected vulnerability, we design an attribution mechanism to identify problematic and potentially malicious apps. We evaluate IoTSan on the Samsung SmartThings platform. From 76 manually configured systems, IoTSan detects 147 vulnerabilities. We also evaluate IoTSan with malicious SmartThings apps from a previous effort. IoTSan detects the potential safety violations and also effectively attributes these apps as malicious.Comment: Proc. of the 14th ACM CoNEXT, 201

Changes in spending, quality indicators, and provider experiences following the introduction of a population-based payment model in dutch primary care:a mixed methods evaluation

Background: In July 2017, a Dutch health insurer and primary care organization jointly implemented the All-In Contract (AIC), a population-based payment model for general practitioners (GPs). Affiliated GP-practices received a capitated payment per enrolled patient covering all GP care and multidisciplinary primary care for chronic conditions. Additionally, the care organization shared in savings and losses on total healthcare spending, contingent upon meeting quality targets. This study investigates the AIC’s impact on spending, quality indicators, and provider experiences 2.5 years after implementation. Methods: We employed a difference-in-differences approach comparing individual-level claims spending from enrollees of participating GP-practices (N = 16,425) with a control group (N = 212,251). Changes in indicators of chronic care management and patient satisfaction were investigated in a before-after analysis due to limited data availability. To contextualize the findings and explore provider experiences, focus groups were conducted with stakeholders involved in the development and/or implementation of the AIC. Results: The AIC was associated with an insignificant 1.2% reduction of average quarterly total spending per enrollee (p = 0.476). We did find a − 10.2% decrease in primary care spending growth (p &lt; 0.01), which was likely related to the indexation rate used for the capitation payment. Spending in other subcategories showed insignificant changes. Changes in patient satisfaction and chronic care management indicators were mixed and modest, but due to the lack of data from non-participating GPs, the extent to which these changes can be attributed to the AIC remains uncertain. The focus group participants reported improvements in provider flexibility in care provision, autonomy, and reduced administrative burdens. However, the focus group results may not fully capture the broader or more diverse experiences of all providers involved. Conclusions: In its first 2.5 years, the AIC had no significant effect on total healthcare spending growth. Trends in quality indicators suggest mixed results for patient satisfaction and chronic care management, while focus group results indicated improved provider experiences. To comprehensively evaluate population-based payment reforms, stakeholders should improve data collection strategies to enable causal assessment of population health, patient experiences, and provider well-being.</p